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目的探讨非乳头状结构的子宫浆液性癌的临床病理特征、鉴别诊断及发病机制。方法收集3例非乳头状结构的子宫浆液性癌的临床及病理资料,采用HE、免疫组化染色及基因测序,分析其组织形态学、免疫表型及TP53基因改变,并复习相关文献。结果患者均为绝经后女性,均因为绝经后阴道出血就诊,平均年龄68岁。巨检:肿瘤为息肉样或扁平斑块状,质脆。镜检:低倍镜下,肿瘤均由分化良好裂隙样腺体组成,肿瘤细胞异型性大,胞质稀少,核分裂象易见。免疫组化示p53、p16和IMP3(+),ER和PR(-),Ki-67阳性指数均>60%。结论非乳头状结构的子宫浆液性癌是子宫浆液性癌中单纯由腺样结构组成的一种类型,具有子宫浆液性癌的临床病理及分子遗传学特征,易诊断为子宫内膜样腺癌,根据其形态结构和细胞分级的显著差异及免疫组化表型可以得出正确的诊断。
Objective To investigate the clinicopathological features, differential diagnosis and pathogenesis of non-papillary thyroid serous carcinoma. Methods The clinical and pathological data of 3 cases of uterine serous carcinoma without papillary structure were collected. The histopathology, immunophenotype and TP53 gene mutation were analyzed by HE, immunohistochemistry and gene sequencing, and the related literatures were reviewed. Results All patients were postmenopausal women, because of postmenopausal vaginal bleeding treatment, the average age of 68 years. Giant check: The tumor is polypoid or flat plaque, crisp. Microscopic examination: low power microscope, the tumor by well-differentiated fissure-like gland tumor cells atypia, sparse, mitotic easy to see. Immunohistochemistry showed p53, p16 and IMP3 (+), ER and PR (-), Ki-67 positive index were> 60%. Conclusion The uterine serous carcinoma with non-papillary structure is a kind of adenoid structure in uterine serous carcinoma. It has the clinicopathological and molecular genetic features of uterine serous carcinoma and is easily diagnosed as endometrioid adenocarcinoma , According to its morphological structure and cell classification of significant differences and immunohistochemical phenotype can draw the correct diagnosis.